PAR Q Form

To be completed before you can join any of our sessions

If you are planning to become much more physically active than you are now, start by answering the questions below. If you are between the ages of 15 and 69, the questionnaire will tell you if you should check with your doctor before you start. If you are over 69 years of age, and you are not used to being very active, check with your doctor.

Common sense is your best guide when you answer these questions.

Please read the questions carefully and answer each one honestly by checking YES or NO.

Has your doctor ever said that you have a heart condition?(*)

YesNoInvalid Input

Has your doctor ever recommended that you should only do physical activity recommended by a doctor?(*)

YesNoInvalid Input

Do you ever feel pain in your chest when you do physical activity?(*)

YesNoInvalid Input

In the past month, have you had chest pain when you were not doing physical activity?(*)

YesNoInvalid Input

Do you ever feel faint or lose your balance because of dizziness or do you ever lose consciousness?(*)

YesNoInvalid Input

Do you have a bone or joint problem that could be made worse by a change in your physical activity?(*)

YesNoInvalid Input

Are you currently taking any medication?(*)

YesNoInvalid Input

If you answered Yes to the question above, please list:

Invalid Input

Are you pregnant or have you had a baby in the last six months?(*)

YesNoInvalid Input

Is there any reason why you should not participate in physical activity?(*)

YesNoInvalid Input

If you answered Yes to the question above, please list:

Invalid Input

Date of birth(*)

Invalid Input

If you answered YES to one or more questions:

Talk with your doctor by phone or in person BEFORE you start becoming much more physically active and BEFORE you have a fitness appraisal.

Tell your doctor about the questionnaire and which questions you answered YES. You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with you doctor about the kinds of activities you wish to participate in and follow his/her advice.

If you answered NO to all questions, you can be reasonably sure that you can start becoming much more physically active – begin slowly and build up gradually.

Please note that if your health changes subsequently that you answer YES to any of the above questions, inform your fitness or health professional immediately, ask whether you should change your physical activity or exercise.